Exploring Rare Traumatic Injuries: A Miniseries of 4 Cases Discussing Epidural Hematomas Bridging the Infratentorial and Supratentorial Regions

Abstract

Supratentorial-infratentorial epidural hematomas (SIEH) are a rare occurrence following traumatic head injuries, representing only 2% of traumatic epidural hematomas. Given the unique anatomical characteristics of the infratentorial region, mainly its small size, surgical intervention is commonly undertaken to alleviate the pressure on the posterior fossa components. Consequently, there is ongoing debate surrounding the optimal surgical approaches.In this report, we present four cases of SIEH that were treated surgically. Furthermore, we conduct a comprehensive review of existing literature, encompassing clinical, radiological, and therapeutic aspects associated with this condition.SIEH are uncommon post-traumatic lesions that require urgent and individualized management on a case-by-case basis, as guided by multiplanar cerebral computed tomography scan findings. Preoperative planning is essential; however, intraoperative exploration and identification of transverse sinus and torcula lesions are crucial for optimal patient care. The surgical approach may be modified intraoperatively based on the nature and extent of these lesions. In all cases, prompt hematoma evacuation and meticulous hemostasis are the two primary objectives of this surgery.

Keywords: Hematoma; Neurosurgery; Transverse sinuses; Traumatology.

FIGURE 1. Axial section of a brain computed tomography scan showing a right supratentorial infratentorial epidural hematoma mainly located on the occipito-parietal region.

FIGURE 2. Axial section of a brain computed tomography scan showing an occipital fracture displacement regarding transverse sinus (red arrow).

FIGURE 3. Axial section of a brain computed tomography scan immediately after surgical evacuation of the supratentorial infratentorial epidural hematoma.

FIGURE 4. Axial brain computed tomography scan showing a right Supratentorial infratentorial epidural hematoma.

FIGURE 5. Three-dimensional-computed tomography scan reconstruction of skull showing a right linear occipito-temporal fracture.

FIGURE 6. Initial CT scan (case 3). Sagittal (A) and axial (B) sections of a brain computed tomography scan showing multiple post-traumatic intracranial lesions including a supratentorial infratentorial epidural hematoma, right cerebellar and frontal contusions. The lesions developing within the posterior fossa were responsible for an upward hydrocephalus.

FIGURE 7. Initial CT scan (case 4). Axial (A) and Sagittal (B) sections of a brain computed tomography scan showing a left Supratentorial infratentorial Epidural hematoma. The red arrow on (A) shows the “swirl sign”.